Business strategy and healthcare

HHS chief dismisses ‘Medicare for all’ as ‘too good to be true’ and the Black Hole that Our Politicians are Creating!

Apologies to all those that read my posts for not posting Sunday evening. My home computer finally crashed. So, here is the weekly post for your review.

These last two weeks have convinced me that both the Republicans and Democrats are flawed and no longer deserve our support. More on that later!

But back to Medicare for All and the confirmation that it may not be the best offer for our health care system. Nathaniel Weixel wrote that the Trump administration’s top health official on Thursday dismissed “Medicare for all” as a promise that’s too good to be true.

“When you drill down into the details, it’s clear that Medicare for all is a misnomer. What’s really being proposed is a single government system for every American that won’t resemble Medicare at all,” Health and Human Services Secretary Alex Azar said during a wide-ranging speech in Nashville, Tenn.

Azar said embracing Medicare for all would mean ignoring the mistakes of ObamaCare, which he called a failure.

“The main thrust of Medicare for all is giving you a new government plan and taking away your other choices,” Azar said.

This was not the first time a top official at the Department of Health and Human Services has tried to discredit the idea of Medicare for all. Centers for Medicare and Medicaid Services Administrator Seema Verma in July called it socialized medicine that would put seniors at risk.

Medicare for all has become increasingly popular among Democrats and is now favored by many of the party’s potential 2020 presidential candidates.

However, many congressional Democrats have yet to completely embrace the idea, and while Sen. Bernie Sanders (I-Vt.) has sponsored a “Medicare for all” bill, there’s no real push for it in Congress.

Republicans have been pointing to Democratic calls for single-payer as a key rebuttal in this year’s midterm campaign, part of an effort to push back against Democratic attacks on GOP bills to repeal ObamaCare.

Aside from attacking Medicare for all, Azar in his speech praised President Trump as a better steward of ObamaCare than former President Obama ever was.

“The president who was supposedly trying to sabotage the Affordable Care Act has proven better at managing it than the president who wrote the law,” Azar said.

He said premiums have been decreasing and there are more plans available for consumers to choose from on state exchanges.

According to Azar, premiums for the typical ObamaCare plan will decrease in 2019 by an average of 2 percent nationwide.

But insurance experts say the main reason premiums are either stable or decreasing this year is because they were so high in 2018. Insurers overpriced their plans this year, driven by the uncertainty over how the Trump administration would handle ObamaCare.

In addition, studies have shown premiums would also be decreasing much more if not for Trump administration policies like the elimination of the individual mandate penalty and expansion of short-term plan.

And now some good, positive news on the healthcare front!

Congress Passes Healthcare Appropriations Bill

Includes funding increase for NIH, $$ for opioid disorder treatment and research

Our friend Joyce Frieden of MedPage wrote that Congress has passed a major appropriations bill that increases funding for medical research and opioid disorder treatment and research.

The bill, which includes a $2-billion increase in the National Institutes of Health budget, passed the House Wednesday evening; the Senate passed it last Tuesday. The $674 billion measure, which also includes funding for the departments of Labor and Defense, now heads to the White House, where President Trump is expected to sign it before Oct. 1, in time to avoid a government shutdown.

Medical groups praised the bill’s passage. “We applaud congressional approval of the FY19 Labor-HHS/Defense spending bill which ensures increased funding for innovative research and public health initiatives to address deadly and disabling diseases,” Mary Woolley, CEO of Research!America, a trade group for medical research organizations, said in a statement. “Passage of the measure before the end of the current fiscal year is also noteworthy and congressional leaders should be commended for their commitment to advancing the bill in a timely fashion. The $2-billion increase for the National Institutes of Health builds on the momentum to accelerate research into precision medicine, Alzheimer’s disease, cancer, and other health threats.”

In addition, she noted, “The measure will also enable the Centers for Disease Control and Prevention to step up efforts to combat antibiotic resistance, and the opioid epidemic through research, treatment, and prevention.”

The appropriations bill also includes $317 million for various rural health initiatives, including $20 million for the Small Rural Hospital Improvement Grant Program for quality improvement and adoption of health information technology, and up to $1 million for telehealth services, “including pilots and demonstrations on the use of electronic health records to coordinate rural veterans’ care between rural providers and the Department of Veterans Affairs electronic health record system,” according to the conference report on the bill that was worked out between the House and Senate.

Other health-related provisions of the bill include:

$1.5 billion for State Opioid Response Grants

$765 million to the Centers for Medicare & Medicaid Services for fighting fraud

$338 million for the Agency for Healthcare Research and Quality, which had been targeted for closure by the Trump administration

$120 million for the Rural Communities Opioids Response Program

The Association of American Medical Colleges (AAMC) also applauded the bill’s passage. In addition to the NIH funding bump, “funding for the Health Resources and Services Administration’s workforce and pipeline programs will help create a strong and culturally competent health care workforce to provide those cures and treatments to vulnerable patients and those living in underserved communities,” AAMC president and CEO Darrell Kirch, MD, said in a statement.

In her statement about the bill’s passage, Rep. Lucille Roybal-Allard (D-Calif.) singled out the healthcare provisions in particular. “I am particularly pleased that [Health and Human Services] programs received such robust funding in this Conference agreement,” she said. “The bill increases funding for three of my top legislative priorities: fighting underage drinking, supporting newborn screening, and reducing maternal mortality.”

In addition, “at a time when this country is experiencing the highest rates of sexually transmitted diseases in history, this bill restores both the Teen Pregnancy Prevention Program and all Title X Family Planning dollars that help our teens gain critical access to reproductive health care and education.”

But not everyone was happy with the bill. “We’re pleased policymakers have likely avoided a shutdown and actually appropriated most of this year’s discretionary budget on time,” said Maya MacGuineas, president of the Committee for a Responsible Federal Budget, in a statement. “But let’s not forgot that Congress did so without a budget and had to grease the wheels with $153 billion to pass these bills. That isn’t function; it’s a fiscal free-for-all.

“Policymakers should not be budgeting by borrowing more; they should put in place a full budget with a plan to bring our borrowing down, not up,” she continued. “Let’s stop patting ourselves on the back for adding hundreds of billions of dollars to the deficit in an orderly manner. Let’s instead work together to stabilize the nation’s finances.”

Anna Almendria wrote that while recounting her allegations against Supreme Court nominee Brett Kavanaugh in front of the Senate Judiciary Committee Thursday, Christine Blasey Ford said the judge had covered her mouth to prevent her from screaming during an assault while the two were teenagers in high school. In follow-up questions, Sen. Dianne Feinstein (D-Calif.) asked Blasey how she could be so sure that it was Kavanaugh who did it.

Blasey, who is a psychology professor at Palo Alto University, offered a lesson in neuroscience in reply. “The same way that I’m sure that I’m talking to you right now, just basic memory functions,” Blasey told Feinstein in response. “And also just the level of norepinephrine and epinephrine in the brain that sort of, as you know, encodes ― that neurotransmitter encodes memories into the hippocampus, and so the trauma-related experience then is kind of locked there whereas other details kind of drift.”

Norepinephrine and epinephrine are two hormones released when the body experiences stress. When a person is experiencing a threat like a sexual assault, these stress neurotransmitters flood the brain and help encode details like the environment and the people who you’re with on the hippocampus, which is a part of the brain that’s responsible for creating and retrieving memories.

Later on in the hearing, she again referred to the hippocampus when responding to Sen. Patrick Leahy’s (D-Vt.) question about her most vivid memory of the alleged assault, which Blasey said took place in the early 1980s.

“Indelible in the hippocampus is the laughter, the uproarious laughter between the two,” she said, referring to Kavanaugh and Mark Judge, the other person Blasey alleges was in the room when the assault took place. “And their having fun at my expense.”

In pairing the retelling of her traumatic experience with explanations of the way assault affects the brain, Blasey is educating the public about how survivors process and store violent memories and can recall them years later.

Sabrina Segal, a psychology professor at Cal State University, Channel Islands, says that Blasey was making a distinction between everyday memories that the brain records during calm, relaxed moments and traumatic memories that the brain encodes during periods of high stress and fear for one’s life.

“The hippocampus is a structure in the brain that we know basically converts short-term memory traces into long-term memory traces,” Segal said, a term that psychologists use to describe the physical change that takes place in the brain when it stores a memory. “We know this because of studies where this part of the brain was removed, and it altered a person’s ability to do that.”

This bit of biology explains why Blasey would be certain of some details like Kavanaugh’s face, or the environment of the room and less so of other details that occurred before the alleged assault, such as the owner of the home where the incident took place. In moments where she feared for her life and was in “fight or flight” mode, she would have details “seared” into her memory, Segal said.

The full mechanics of this response also involve the amygdala, an almond-shaped structure in the brain, which perceives and responds to danger.

“What a lot of people don’t know is that your body releases adrenaline, which is a stress hormone, and almost simultaneously your brain will release [norepinephrine] in the amygdala,” Segal said. “It’s a potency maker in terms of being able to strengthen the memory.”

Research shows that it is common for survivors of sexual trauma to strongly remember the details of the event itself but not have many memories of other details around the event.

“When something is incredibly traumatic and emotional, that [norepinephrine] is going to make specific details etched in, and you will never forget them,” Segal said. “The fact that she’s had these memories for 20 years is not shocking to me in any way.”

Negar Fani, an assistant professor at Emory University who specializes in the neurobiology of post-traumatic stress disorder, says that this traumatic memory-storing process has a strong evolutionary purpose.

“It’s so that you can avoid things that could potentially harm you in the future,” Fani said. “When you encounter and encode these contextual aspects of the memory, you’ll avoid things that even remotely relate to that trauma memory.”

Fani said this could explain why Blasey requested that Kavanaugh not be present in the room during her testimony. “This person who assaulted her produces that same fight or flight reaction,” Fani said. “Because he’s a critical part of the threat context, it’s going to arouse her fight or flight system, and it’s hard to think clearly when that fight or flight system is engaged.”

But there is a lesson for Dr. Ford, and these experts, who has accused the supreme court nominee, Judge Kavanaugh, of sexual harassment saying that the norepinephrine and epinephrine levels in her hipocampus basically cements that memory 100% in her hippocampus. Interesting!! If that were true how come that she doesn’t remember where it took place, when it took place and how she got home.

Well, the last article the “professionals” tries to explain these differences. Alas, this “expert”, along with those others, who are not medical doctors with no training in neurology or medicine don’t understand the effect of alcohol has on the levels of norepinephrine in the hippocampus or chose not to mention these facts. Study up Doc/PhD, before you try to sound so sure of yourself.

Now also remember the Prosecutor that the Republicans brought in to question Ford and Kavanaugh. Rachel Mitchell, the prosecutor who questioned Christine Blasey Ford on behalf of Republican senators last week during an emotional hearing before the Senate Judiciary Committee, released a memo late Sunday detailing why no “reasonable prosecutor” would bring a case against Brett Kavanaugh given the “evidence” that exists against him.

“A ‘he said, she said’ case is incredibly difficult to prove. But this case is even weaker than that,” Mitchell said, explaining the case’s “bottom line.”

Ironically, Mitchell’s language mirrors the vernacular of former FBI Director James Comey, who similarly argued in July 2016 that “no reasonable prosecutor” would bring charges against Hillary Clinton for her use of a private email server.

The career Arizona prosecutor, who specializes in sex-related crimes, goes on to outline eight reasons why no “reasonable prosecutor would bring this case,” explaining the evidence fails to “satisfy the preponderance-of-the-evidence standard.”

Ford has not offered a consistent account of when the alleged assault happened

Mitchell explained that initially Ford said the assault occurred in the “mid-1980s,” but later changed the date to the “early 80s.” But when she met with the polygraph administrator, Ford crossed out the word “early” for unknown reasons.

Ford has also described the incident occurring in the “summer of 1982” and her “late teens” — despite claiming it happened when she was 15.

“While it is common for victims to be uncertain about dates, Dr. Ford failed to explain how she was suddenly able to narrow the time frame to a particular season and particular year,” Mitchell said.

Ford has struggled to identify Judge Kavanaugh as the assailant by name

Mitchell explained Ford neither identified Kavanaugh by name during marriage counseling in 2012 or individual counseling in 2013. Ford’s husband claims she identified Kavanaugh in 2012, but Mitchell noted that Kavanaugh’s name was widely circulated as a potential Supreme Court pick should then-Republican presidential nominee Mitt Romney have won the presidency.

“In any event, it took Dr. Ford over thirty years to name her assailant,” Mitchell wrote. “Delayed disclosure of abuse is common so this is not dispositive.”

When speaking with her husband, Ford changed her description of the incident to become less specific

According to Mitchell, Ford told her husband before they married that she had been the victim of a “sexual assault,” but told the Washington Post that she told her husband she was a victim of “physical abuse.”

“She testified that, both times, she was referring to the same incident,” Mitchell said.

Ford has no memory of key details of the night in question — details that could help corroborate her account

Mitchell explained:

Ford does not remember who invited her to the “party, how she heard about it, or how she got there”

Ford does not remember whose house the assault occurred or where the house is located with any specificity

Ford remembers very specific details about that night that are unrelated to the assault, such as how many beers she consumed and whether or not she was on medication

Perhaps the most significant hole in Ford’s memory, Mitchell said, is the fact that Ford does not remember how she returned home from the party.

Factually speaking, the location of the party that Ford identified to the Washington Post is a 20-minute drive from her childhood home. And it was only during her testimony last week that she agreed for the first time that someone had driven her somewhere that night. Ford remembers locking herself in a bathroom after the alleged assault, but cannot identify who drove her home.

Significantly, no one has come forward to identify themselves as the driver.

“Given that this all took place before cellphones, arranging a ride home would not have been easy. Indeed, she stated that she ran out of the house after coming downstairs and did not state that she made a phone call from the house before she did, or that she called anyone else thereafter,” Mitchell said.

Ford’s account of the alleged assault has not been corroborated by anyone she identified as having attended — including her lifelong friend

As widely reported, Mitchell explained that each individual Ford identified as having been at the party has submitted sworn statements — under penalty of felony — that they do not remember the party and cannot recall or corroborate any detail that Ford alleges.

Ford has not offered a consistent account of the alleged assault

Ford claimed in her letter to Sen. Dianne Feinstein (D-Calif.) that she heard Kavanaugh and Mark Judge talking downstairs while hiding in a bathroom after the assault. But she testified that she could not hear anyone, and only “assumed” people were talking.

Meanwhile, Ford’s therapist’s notes show that she said there were four boys in the bedroom when she was assaulted. However, she told the Washington Post it was only two, and blamed the error on her therapist. Also, in Ford’s letter to Feinstein she said there were “me and 4 others” at the party. However, in her testimony, she said there were “four boys” at the party in addition to herself and Leland Keyser, her female friend.

Additionally, “Dr. Ford listed Patrick ‘PJ’ Smyth as a ‘bystander’ in her statement to the polygrapher and in her July 6 text to the Washington Post, although she testified that it was inaccurate to call him a bystander. She did not list Leland Keyser even though they are good friends. Leland Keyser’s presence should have been more memorable than PJ Smyth’s,” Mitchell said.

7. Ford has struggled to recall important recent events relating to her allegations, and her testimony regarding recent events raises further questions about her memory

Mitchell explained that Ford is unable to accurately remember her interactions with the Washington Post, such as what she told reporters or whether or not she provided them with a copy of her therapist’s notes.

Also of significance is Ford’s claim that she wished to remain confidential since she submitted her assault allegations to a person operating the Washington Post’s tip line. She testified that she did this due to a “sense of urgency,” claiming she did not know how to contact the Senate Judiciary Committee. However, she was unable to explain how she knew to contact the offices of Feinstein and Rep. Anna Eshoo (D-Calif.).

Also, Ford cannot recall if she was recorded, via audio or video, during the administration of her polygraph, nor can she remember if the polygraph was administered on the same day as her grandmother’s funeral or the day after.

“It would also have been inappropriate to administer a polygraph to someone who was grieving,” Mitchell said.

Ford’s description of the psychological impact of the event raises questions

Ford testified that she suffers from anxiety, PTSD, and claustrophobia, which explains her fear of flying. However, she testified that she has flown many times in the last year, and flies on a regular basis for her hobbies and work.

Meanwhile, Ford testified that the assault affected her academically in college. However, she never claimed it affected her in high school after the assault allegedly occurred.

“It is significant that she used the word ‘contributed’ when she described the psychological impact of the incident to the Washington Post. Use of the word ‘contributed’ rather than ’caused’ suggests that other life events may have contributed to her symptoms. And when questioned on that point, said that she could think of ‘nothing as striking as’ the alleged assault,” Mitchell explained.

And now we are going to have the FBI do an additional investigation after they have already vetted this candidate 6 times. That’s right, 6 times for his other judicial positions!

Besides this expert and witness to the horrible things that the judge has done, the behavior of most of the Democrats especially, but also some of the Republicans really sickens me. It represents childish, uncivil and I think truly unethical behavior, which has no place in this confirmation hearing. Do you all remember all that you did in high school and or college? I doubt it and some of these allegations can be interpreted in various ways. But trust me I am no fan of sexual aggressive behavior on anyone’s part but some of these allegations have to be taken in context and timing and in lieu of the behaviors of the time and grouping behaviors. Really??

I remember college gals exposing themselves when drunk or even after only one or two drinks as well as “men and women” away from home in college who were so drunk that they fell on each other, etc.

But that being what it is I am still angrier with our Senators and Representatives who by their behavior and lack of respect for Judge Kavanaugh and their anger for President Trump have created a circus. All this horrible behavior, the anger, hatred and the vitriol has convinced me to vote for independents and not anyone from each of our popular parties, unless it only leaves me the Republican as my only choice.

I was even going to vote for a Democrat in our Senate race because of the lack of any positive input or suggestions for health care decisions from the two term physician who has filled that spot. But now it will be the independent gentleman who gets my vote. I hope that many of you out there when you get to vote in November carefully make your choices. We the voters are the only people that can turn this black era in our society’s history around. The Democrats are pitting Democrats against Republicans, whites against Afro-Americans, “straights against gays/LGTBXXX and finally men against women. For what? They want control of our government and to get on with their agenda. Horrifying!!

And now here is another insult by our politicians. I had an interesting experience on Friday afternoon while waiting for our train to New York City. Our Acela train was delayed by 1 ½ hours so that Senator Coons could give interviews in D.C. regarding the Kavanaugh hearing. Yes, they held up the train in D.C. Union Station, so that the senator could complete his interviews and claim the Business Car for him and his troop. Unbelievable!!

Next, more discussion on single payer health care choices and if there are other alternatives to consider.